Nancy Lanza part 3

James Coplan, MD, continues his review of the OCA report on the shootings at Sandy Hook Elementary School, focusing on Nancy Lanza’s mental health.

Previous articles on this topic:

Shooting At Sandy Hook Elementary School – Report Of The Office Of The Child Advocate.

Who’s Story Is It, Anyway?

Unfounded Claims Of Illness

Now we enter the realm of informed speculation.

We know that Nancy Lanza represented herself to others as having a variety of medical disorders (Multiple Sclerosis, seizures, an immunologic disorder). What we don’t know is whether she actually believed it herself. If she truly believed that she was suffering from a crippling, terminal illness, despite repeated normal exams and test results, that would point us in the direction of Illness Anxiety Disorder, Somatic Symptoms Disorder (SSD), and Conversion Disorder (Functional Neurological Symptoms Disorder). If she was experiencing symptoms (albeit psychogenic in origin), then SSD or Conversion Disorder rise to the top of the list. If she were consciously “making it all up,” then malingering would need to be considered, but given the totality of what we know, this option seems unlikely. If she were inventing illness in herself in a “driven” way, stemming from unconscious, deeply rooted psychiatric need, then Factitious Illness Disorder becomes a leading contender, diagnostically. Regardless of exactly how the cards fall, “Mrs. Lanza’s statements regarding her medical condition…[raise] important questions regarding the parents’ mutual understanding of the trajectory of [Adam]’s educational and mental health treatment, much of which was guided by Mrs. Lanza’s interpretation of unfolding events.” (OCA p 31)

There is also a glaring inconsistency in Nancy Lanza’s behavior that we cannot resolve, and that the committee does not address. In her emails to friends, Nancy Lanza confided her concerns about her supposedly dire medical status, while at the same time asking her friends to keep the information confidential. She also wrote that she herself “intended to be discreet about her diagnosis so as to save loved ones ‘from unnecessary worry’” (OCA p. 28). And yet, interviews with Peter Lanza (her ex-husband, and Adam’s father) make it clear that Nancy convinced him that she had MS. Furthermore, far from sparing her family from “unnecessary worry,” she also unloaded her fears onto Adam. In a 2008 email to Adam (Adam was 16 at the time), Nancy Lanza wrote:

“There is nothing that I can do about my diagnosis, and I do try to be as healthy as I can, despite the prognosis. I am sure that you noticed that I exercise regularly and do my best to stay in good shape. It’s not like I have the attitude that since I will be crippled anyway I may as well give up and get fat and sedentary now. I am working hard to stay as healthy as I can, for as long as I can.” (OCA p. 75)

Clearly, Nancy’s admonition to her friends and her actual behavior vis-à-vis her husband and Adam do not match up, but what this means is hard to say. Persons with malingering are consciously seeking secondary gain, which may include sympathy. Persons with Factitious Disorder are not consciously seeking sympathy, although that may still be an unconscious factor. Which is it in this case (if either)? Once again, we have no way of knowing. We have access to Nancy Lanza’s writings, but not her actual inner emotional and cognitive state. Irrespective of the inner workings of Nancy Lanza’s psyche, what was the impact on Adam of being burdened with his mother’s worries? How young was Adam when his mother began telling him her “diagnosis” and the possibility that she would “be crippled” at some future date? We will return to these questions shortly.

Finally, what do we make of Nancy Lanza’s repeatedly expressed concerns about Adam’s risk for seizures, and her declaration (immediately after Adam started medication for anxiety) that he had become “vegetative,” and was “unable to lift his arm”? Factitious Disorder imposed on others comes to mind, but lacking firsthand knowledge of what was in Nancy Lanza’s mind, we cannot say. Furthermore, although she repeatedly voiced fear of seizures in Adam, she did not take him for batteries of tests – one of the hallmarks of Factitious Disorder. On the contrary, Nancy Lanza generally shielded Adam from medical intervention (including mental health services under the umbrella of “medical intervention”).

In fact, Nancy Lanza’s tendency to shield Adam from outside influences of all kinds rapidly became a problem unto itself. More on that next time.

Until then.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Stay connected, join Dr. Coplan on Facebook and Twitter.